COMPLICATION SIGN SYMPTOMS ETIOLOGY/OTHER MANAGEMENT

Asymptomatic Infiltrates (AI)  Presence of infiltrates  Lens cessation

(0.2mm) in the  If viral and/or severe: require
cornea w/o any steroid, NSAID, antibiotic (as
sign/symptoms single or combination)
 No staining  If staining present: artificial
Asymtomatic Infiltrative Keratitis (AIK)  Presence of infiltrates tears, antihistamine, ocular
(up to 0.4mm) in the decongestion, cold
cornea without pt compression
symptoms.  Use preservative free products
 Ant. stroma (sub-  Regimen care: solution,
epithel) wearing schedule, lens
 Punctate staining material
 Mild to moderate LR  Patient re-education

Infiltrative Keratitis (IK)  Infiltration  Mild to moderate

(midperiphery to irritation
periphery) in anterior  redness
stroma with/w/o  occasional
epithelial discharge.
involvement (sub-  During the day
epithelial). and the focal
 Small sizes, multiple, infiltrates are
moderate diffuse irregular.
infiltration.
 Slight to mod staining
Contact Lens-Induced Acure Red Eye  Inflammation in  Moderate to  EW (closed-eye  Discontinue CL wear
(CLARE) cornea and severe redness hypoxia) immediately
conjunctiva (360º)  irritation to  CL binding overnight  Healing takes 2-3 weeks up to
 Multiple focal moderate pain  Entrapped debris & 3 months
infiltrates, small sizes  tearing deposits  Monitor carefully of recurrence
and diffuse  photophobia.  Gram-negative  Antibiotic may not be required,
infiltration in the  Pain upon bacteria but sometimes necessary
midperi to peri (2- awakening,  Sensitivity to CL care  Change to daily wear basis
3mm from limbus). photophobia and products  Lubrication
 Minimal or no tearing.  Debilitated general  Low toxicity of care products
staining health
 Some seasonal
variation
Contact Lens-Induced Peripheral  Ulceration of the  Limbal and bulbar  Bacterial toxins  Discontinue CL wear
Ulcer (CLPU) corneal epithelium redness  Staphylococcus sp. immediately
with underlying  Tearin  Corynebacterium  Rapid healing
inflammation of the  moderate to sp.  Monitor carefully for first 24
corneal stroma severe pain  Culture-negative hrs
 Infiltration and  foreign body  Interaction of CL &  Prophylaxis- Antibiotic
necrosis of anterior sensation epithelial surfaces  Resolves with scarring
stroma. (sometimes  Scarring due to
 Focal infiltrates with asymptomatic). post-inflammatory
diffuse infiltration cicatrization (scar)
surrounding it, in  Seasonal factor may
 midperiphery to apply
periphery.

Microbial Keratitis (MK)  Infection of the  Limbal and bulbar  More common in  Discontinue CL wear
cornea by excavation redness EW (prolonged eye immediately
of the corneal  moderate to closure)  Refer to ophthalmologist:
epithelium, severe pain (rapid  Hypoxia - Swabs- to determine the
Bowman’s layer and onset)  CL deposits type of microbe(s)
stroma.  decreased visual  Hygiene issues, non- - Prophylaxis- Antibiotic,
 Infiltration and acuity compliance Steroids (once infection
necrosis of those  discharge, tearing  Bacterial adherence controlled)
tissues above.  photophobia esp. Gram-negative  Healing is slow- months
 Irregular focal  Lid puffiness P. aeruginosa  Resolves with scarring
infiltrates (>1mm)  Can be viruses,  Continue wearing the lenses
with diffuse fungi, or protozoa once completely resolved? No,
infiltration.  Protection against due to scarring. Prosthetic can
 Central and disinfection to cover scar
paracentral afforded organisms
infiltrates. by formation of
their own biofilm